Radiofrequency catheter ablation of premature ventricular contractions from the mitral annulus in patients without structural heart disease

INTRODUCTION: We previously reported the clinical benefits of radiofrequency catheter ablation (RFCA) of premature ventricular contractions (PVCs) from the right ventricular outflow tract or near the His‐bundle, which can often deteriorate the clinical status. PVCs from the mitral valve (MA‐PVCs) also often deteriorate the patients’ clinical status. This study aimed to evaluate the effect of ablating MA‐PVCs with RFCA from a trans‐interatrial septal approach on the clinical status in symptomatic patients with frequent MA‐PVCs without structural heart disease. METHODS: The frequency of PVCs per the total heart beats by 24‐hours Holter monitoring and New York Heart Association (NYHA) functional class in 22 patients with MA‐PVCs were evaluated before and 6 months after RFCA. RESULTS: Procedural success was achieved in 20 (91%) of 22 patients. Of the 22 patients, in 15 (68%) and 1 (5%) patient, a successful RFCA on the left ventricular side of the MA using the trans‐interatrial septal approach and trans‐coronary sinus approach was achieved. Interestingly, in four (18%) patients, a successful RFCA on the left atrial (LA) side of the MA using a trans‐interatrial septal approach was achieved. Ablating MA‐PVCs readily improved the NYHA functional class compared to that before. A ≥0.62 peak deflection index and ≤30 years old may be one of the important predictors of successfully ablated MA‐PVCs from the LA side of the MA. CONCLUSIONS: RFCA produces clinical benefits in patients with MA‐PVCs. Further, it may be necessary to initially consider a trans‐interatrial septal approach to ablate these PVCs.